Provider Demographics
NPI:1265711261
Name:JOHN B TURNER MD PA
Entity type:Organization
Organization Name:JOHN B TURNER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITERSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-676-9300
Mailing Address - Street 1:800 S NOVA RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9048
Mailing Address - Country:US
Mailing Address - Phone:386-676-9300
Mailing Address - Fax:386-676-9050
Practice Address - Street 1:800 S NOVA RD
Practice Address - Street 2:SUITE I
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9048
Practice Address - Country:US
Practice Address - Phone:386-676-9300
Practice Address - Fax:386-676-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00339972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065397700Medicaid
FL64447Medicare PIN
FL065397700Medicaid